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Absorption and Hemodynamic Effects of Airway Administration of Adrenaline in Patients with Severe Cardiac Disease
- Konstantinos Raymondos, MD;
- Bernhard Panning, MD;
- Martin Leuwer, MD;
- Guido Brechelt;
- Thomas Korte, MD;
- Michael Niehaus, MD;
- Jürgen Tebbenjohanns, MD; and
- Siegfried Piepenbrock, MD
Abstract
Background: If intravenous access cannot be attained during resuscitation of adult patients, endotracheal application of at least 2 mg of adrenaline is recommended. However, the effects of this intervention have not yet been demonstrated in adults.
Objective: To demonstrate the effects of adrenaline administered through the airways.
Design: Prospective clinical trial.
Setting: Operating theater at university hospital.
Patients: 34 patients receiving implantable cardioverter defibrillators under general anesthesia.
Intervention: When mean arterial pressure decreased below 80 mm Hg, 100 times the effective central intravenous dose of adrenaline (mean ± SD, 1.3 ± 0.6 mg [range, 0.7 to 3 mg]) was administered over 5 seconds into the endotracheal tube or through a bronchial catheter. Ten forced ventilations followed.
Measurements: Hemodynamic variables were recorded with a polygraph recorder. Adrenaline levels were measured in 13 patients.
Results: Plasma levels and arterial pressure increased in all patients (P < 0.002). Higher plasma levels (P < 0.039) and greater arterial pressure (P < 0.001) were achieved with this method than with intravenous injection. The effects of adrenaline did not differ between the two airway routes. Sustained ventricular arrhythmia did not occur.
Conclusion: These substantial effects support the standard recommendation to consider the airways as an alternate route for at least 2 mg of adrenaline during resuscitation.
Article and Author Information
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Acknowledgments: The authors thank Dr. H.A. Adams for adrenaline and noradrenaline determination and Dr. Hartmut Hecker for his assistance with biostatistical analysis.
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Grant Support: By institutional funding from Förderkreis für Fortbildung und Forschung in der Anästhesie, Intensivmedizin, Schmerztherapie und Notfallmedizin der Medizinischen Hochschule Hannover e.V.
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Requests for Single Reprints: Konstantinos Raymondos, MD, Department of Anesthesia, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; e-mail, KRaymondos{at}aol.com.
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Requests To Purchase Bulk Reprints (minimum, 100 copies): the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints{at}mail.acponline.org.
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Current Author Addresses: Drs. Raymondos, Panning, Leuwer, and Piepenbrock and Mr. Brechelt: Department of Anesthesia, Medizinische Hochschule Hannover, Carl-Neuberg-Str.1, 30625 Hannover, Germany.
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Drs. Korte, Niehaus, and Tebbenjohanns: Department of Cardiology, Medizinische Hochschule Hannover, Carl-Neuberg-Str.1, 30625 Hannover, Germany.
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Author Contributions: Conception and design: K. Raymondos, B. Panning.
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Analysis and interpretation of the data: K. Raymondos, B. Panning, M. Leuwer, G. Brechelt, T. Korte, M. Niehaus, J. Tebbenjohanns, S. Piepenbrock.
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Drafting of the article: K. Raymondos, B. Panning, T. Korte.
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Critical revision of the article for important intellectual content: B. Panning, M. Leuwer, G. Brechelt, T. Korte, M. Niehaus, J. Tebbenjohanns, S. Piepenbrock.
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Final approval of the article: K. Raymondos, B. Panning, M. Leuwer, G. Brechelt, T. Korte, M. Niehaus, J. Tebbenjohanns, S. Piepenbrock.
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Obtaining of funding: K. Raymondos.
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Administrative, technical, or logistic support: B. Panning, J. Tebbenjohanns, S. Piepenbrock.
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Collection and assembly of data: K. Raymondos, B. Panning, G. Brechelt.
- Copyright ©2004 by the American College of Physicians
